Bunion Treatment

Procedure overview

What is a bunion?

A bunion (hallux valgus) is an enlargement of the bone or tissue around a joint at the base of the big toe or at the base of the little toe (in which case it is called a "bunionette" or "tailor's bunion"). Bunions often occur when the joint is stressed over a prolonged period. Ninety percent of bunions occur in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis, which often affects the big toe joint.

Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling.

If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot.

Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot. Please see these procedures for additional information.

Different types of bunion surgery

The type of surgical procedure performed depends upon the severity of the bunion, the individual’s age, general health, activity level, and the condition of the bones and connective tissue. Other factors may influence the choice of a procedure used:

• Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone and realign the muscles, tendons, and ligaments surrounding the joint.
• Moderate bunion. For a moderate bunion, the surgeon may cut the bone and shift it to its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned.
• Severe bunion. For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments.
• Arthritic bunion or big toe joint. If the joint is damaged beyond repair, as is commonly seen in arthritis, it may need to be reconstructed or replaced with an artificial joint. Joint replacement implants may be used in the reconstruction of the big toe joint.

Reasons for the procedure

Reasons to undergo bunion surgery may include severe foot pain that occurs even when walking or wearing flat, comfortable shoes. Surgery may also be indicated when chronic big toe inflammation and swelling does not subside with rest or medications.

Other reasons for surgery include toe deformity, a drifting in of the big toe toward the small toe, and an inability to bend and straighten the big toe.

There may be other reasons for your doctor to recommend bunion surgery.

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to:

• Stiffness
• Numbness
• Swelling
• Delayed healing
• Infection

Other complications may include recurrence of the bunion, nerve damage, and continued pain. The surgery may also result in overcorrection of the problem, in which the big toe extends away from the other toes.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your doctor.
• You may be asked to fast for 8 hours before the procedure, generally after midnight.
• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

Bunion surgery may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

Most bunion surgery is performed under ankle block anesthesia, in which your foot is numb, but you are awake. Occasionally, general or spinal anesthesia is used.

Generally, bunion surgery follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
2. An intravenous (IV) line may be started in your arm or hand.
3. The skin over the bunion will be cleansed with an antiseptic solution.
4. If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using intravenous medication.
5. The doctor will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based on the severity of the bunion.
6. The doctor will close the opening with stitches and apply a sterile bandage or dressing.

After the procedure

After your surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. The circulation and sensation of the foot will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

Your doctor will give you specific instructions for caring for your foot at home during the first few weeks after surgery. You may be discharged from the hospital wearing a special surgical shoe or cast to protect your foot.

Once you are at home, you will need to rest and keep the foot elevated on 1 or 2 pillows to help reduce pain and swelling. Your doctor may also recommend that you apply ice and limit walking. You may be advised to use a cane or walker following surgery.

It is important to keep the dressing clean and dry. You should cover the dressing with a plastic bag or plastic wrap and tape it with plastic tape when showering. An alternative is to take a sponge bath. The stitches will be removed during a follow-up visit, generally scheduled about 2 weeks after surgery.

Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. Your doctor may also prescribe antibiotics to help prevent infection following your surgery.

Notify your doctor to report any of the following:

• Fever
• Redness, swelling, bleeding, or other drainage from the incision site
• Increased pain around the incision site
• Swelling in lower leg of the affected foot

You doctor will advise you as to your postoperative activities. Your foot may require continuous support from dressings or a brace for 6 to 8 weeks after surgery. You may need to refrain from driving for about a week after surgery.

Exercises or physical therapy may be recommended to help the foot recover its strength and range of motion after surgery. High heels should be avoided for at least 6 months after surgery.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.